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Incident/Complaint Report Form

Marymount Manhattan College makes every effort to listen and respond to its community members. We aim to serve courteously and efficiently, including acting in accordance to college policies and state and federal laws. Please use this form to submit a concern or complaint. Once it has been reviewed, you will be contacted through your MMC e-mail address by the appropriate person or office. You may choose to submit this concern/complaint anonymously, in which case the College will do its best to address it without the ability to reach out to you for more information or to alert you as to how your concern/complaint has been addressed. Please provide as much information as possible.

Reports in particular areas will be routed as follows:

• Bias Discrimination Incidents — Katie Langan, Bree Bullingham, and/or Emmalyn Yamrick
• Sexual Misconduct/Title IX Incidents — Desiree Sholes, Title IX Coordinator
• General Conduct Incidents Involving Faculty — Katie Langan, Interim Vice President of Academic Affairs/Dean of the Faculty
• General Conduct Incidents Involving Staff — Bree Bullingham, Associate Vice President for Human Resources
• General Conduct Incidents Involving a Student(s) — Emmalyn Yamrick, AVP for Student Success and Engagement/Dean of Students

Please use the following to report facilities or IT concerns:

• College Facilities- All building and facilities concerns can be reported to 212-517-0449
• Information Technology- Any user can contact IT Help Desk at (212)517-0580, or send email to usersupport@mmm.edu.

Background Information

Your full name:

Your cell phone number:

Your MMC email address:

Email address must be of a valid format.

Nature of concern or complaint(Required):

This field is required.

Is this related to(Required):

This field is required.

Date of incident(Required):

This field is required.

Where did this Occur(Required):

This field is required.

Involved Parties

Name or Organization

Select Gender

Select Role

ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Summary of Concern or Complaint

Please briefly explain the nature of your concern, complaint, or question. If it involves a specific incident, please explain the details, including who was involved, what transpired, and what actions you or others took as a result.(Required) This field is required.

Background Information

Involved Parties

Summary of Concern or Complaint

Submission